Diagnostic Validity of Clinical Provocative Tests in Carpal Tunnel Syndrome

Abstract

Introduction: Carpal tunnel syndrome (CTS) is the most prevalent mononeuropathy worldwide. Clinical diagnosis of CTS is important for screening of the condition and selecting cases to be confirmed with nerve conduction study (NCS), considering the limited availability of the latter. Numbers of clinical provocative tests have been designed for CTS. This study was conducted to compare the diagnostic validity of five widely used clinical provocative tests for CTS.

Methods: This was a case-control diagnostic accuracy study conducted on NCS-proven 140 CTS cases and 202 controls. Five clinical provocation tests – Phalen’s test, reverse Phalen’s test, Tinel’s test, Durkan’s test and arm raising test were performed on all participants. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, overall accuracy and weighted kappa coefficient were calculated.

Results: Phalen’s test, reverse Phalen’s test, and Tinel’s test showed low sensitivity (48-50%) despite their high specificity (91-92%) and moderate accuracy (73-75%). Durkan’s test demonstrated 73% sensitivity, 86% specificity and 80% accuracy. Arm raising test results exhibited a poor sensitivity of 42%, despite a high specificity of 89%. Durkan’s test had the strongest degree of agreement with the NCS diagnosis with a weighted kappa coefficient of 0.6.

Conclusion: Durkan’s test exhibited the best diagnostic performance among five most commonly used clinical provocative tests for CTS.

Green Life Med. Col. J 2026;11(2): 50-53